<?php echo $header; ?>


		  <!-- Start - Left Side -->
	      <div id="left" class="span-24">
	      <div class="span-24 checkout">
	      	<div class="heading_x span-24">
					<span><?php echo $heading_title; ?></span>
					<hr />
				</div>&nbsp;
	      		 <?php if ($error_warning) { ?>
			    	<div class="warning"><?php echo $error_warning; ?></div>
			    <?php } ?>
	      		<form action="<?php echo str_replace('&', '&amp;', $action); ?>" method="post" enctype="multipart/form-data" id="create">
	      			
	      		<TABLE class="register_form" width=100% border="1" >
	      			
	      		<tr>
	      			<td class="bg"  width="1%"></td>
	      			<td class="bg tb_label"   width="1%">
	      				<img src="./catalog/view/theme/galib/image/require.png" /> <?php echo $entry_user_id; ?>
      				</td>
	      			<td class="tb_input"><input type="text" name="user_id" value="<?php echo $user_id; ?>" />
              <?php if ($error_user_id) { ?>
              <span class="error"><?php echo $error_user_id; ?></span>
              <?php } ?></td>
	      		</tr>
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<img src="./catalog/view/theme/galib/image/require.png" /> <?php echo $entry_password; ?>
	      				</td>
		      			<td class="tb_input"><input type="password" name="password" value="<?php echo $password; ?>" />
              <?php if ($error_password) { ?>
              <span class="error"><?php echo $error_password; ?></span>
              <?php } ?></td>
	      		</tr>
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<img src="./catalog/view/theme/galib/image/require.png" /> <?php echo $entry_confirm; ?>
	      				</td>
		      			<td class="tb_input"><input type="password" name="confirm" value="<?php echo $confirm; ?>" />
              <?php if ($error_confirm) { ?>
              <span class="error"><?php echo $error_confirm; ?></span>
              <?php } ?></td>
	      		</tr>
	      		
	      		
	      		
	      		
	      		<tr>
	      			<td class="bg"  width="1%"></td>
	      			<td class="bg tb_label"   width="20%">
	      				<img src="./catalog/view/theme/galib/image/require.png" />
		      			<img src="./catalog/view/theme/galib/image/label_name.png" />
      				</td>
	      			<td class="tb_input"><input type="text" name="firstname" value="<?php echo $firstname; ?>" /></td>
	      		</tr>
	      		<tr>
	      			<td class="bg"  width="1%"></td>
	      			<td class="bg tb_label"   width="20%">
	      				<img src="./catalog/view/theme/galib/image/require.png" />
		      			<img src="./catalog/view/theme/galib/image/label_lastname.png" />
      				</td>
	      			<td class="tb_input"><input type="text" name="lastname" value="<?php echo $lastname; ?>" />
              <?php if ($error_lastname) { ?>
              <span class="error"><?php echo $error_lastname; ?></span>
            <?php } ?></td>
	      		</tr>
	      		
	      		
	      		
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<img src="./catalog/view/theme/galib/image/label_idc.png" />
	      				</td>
		      			<td class="tb_input"><input type="text" name="thai_id" value="<?php echo $thai_id; ?>" />
		      				<span class="required protect"><img src="./catalog/view/theme/galib/image/protect.png" /></span>
                    <?php if ($error_thai_id) { ?>
                    <span class="error"><?php echo $error_thai_id; ?></span>
              <?php } ?></td>
	      		</tr>
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
	      				<img src="./catalog/view/theme/galib/image/require.png" />
		      			<img src="./catalog/view/theme/galib/image/label_address.png" />
	      				</td>
		      			<td class="tb_input">
		      				   				
		      			 	<input type="text" name="address_1" value="<?php echo $address_1; ?>" /><br/>
		      			 	<input type="text" name="address_2" value="<?php echo $address_2; ?>" /><br/>
		      			 	<input type="text" name="address_3" value="<?php echo $address_3; ?>" />
              <?php if ($error_address_1) { ?>
              <span class="error"><?php echo $error_address_1; ?></span>
              <?php } ?></td>
	      		</tr>
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<?php echo $entry_postcode; ?>
	      				</td>
		      			<td class="tb_input"><input type="text" name="postcode" value="<?php echo $postcode; ?>" />
			 			 <?php if ($error_postcode) { ?>
			              <span class="error"><?php echo $error_postcode; ?></span>
			              <?php } ?></td>
	      		</tr>
	      		
	      		 <tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<img src="./catalog/view/theme/galib/image/require.png" /> <?php echo $entry_telephone; ?>
	      				</td>
		      			<td class="tb_input"><input type="text" name="telephone" value="<?php echo $telephone; ?>" />
              <?php if ($error_telephone) { ?>
              <span class="error"><?php echo $error_telephone; ?></span>
              <?php } ?></td>
	      		</tr>
	      		
	      			<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      			<img src="./catalog/view/theme/galib/image/hphone.png" />
		      				<?php echo $entry_fax; ?>
	      				</td>
		      			<td class="tb_input">
		      				<input type="text" name="fax" value="<?php echo $fax; ?>" /> 
	      				</td>
	      		</tr>
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<img src="./catalog/view/theme/galib/image/require.png" /> <?php echo $entry_email; ?>
	      				</td>
		      			<td class="tb_input"><input type="text" name="email" value="<?php echo $email; ?>" />
              <?php if ($error_email) { ?>
              <span class="error"><?php echo $error_email; ?></span>
              <?php } ?></td>
	      		</tr>
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<?php echo $entry_birthday; ?>
	      				</td>
		      			<td class="tb_input birthday cufon">
		      				<input type="text" name="birth_day" class="form_birth" value="<?php echo $birth_day; ?>" /><?php echo $entry_birth_day; ?>
		      				 <input type="text" name="birth_month" class="form_birth" value="<?php echo $birth_month; ?>" /><?php echo $entry_birth_month; ?>
		      				 <input type="text" name="birth_year" class="form_birth" value="<?php echo $birth_year; ?>" /><?php echo $entry_birth_year; ?>
		      				 <span class="required"><?php echo $event; ?></span>
			 			 </td>	 
	      		</tr>
	      		
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<?php echo $entry_facebook; ?>
	      				</td>
		      			<td class="tb_input cufon"><input type="text" name="facebook" value="<?php echo $facebook; ?>" />
			 			 	<span class="required"><?php echo $event; ?></span>
		      			</td>
	      		</tr>
	      		
	      		
	      		
	      		
	      		<!-- not used field 
	      		<tr>
		      			<td class="bg"  width="1%">&nbsp;</td>
		      			<td class="bg tb_label"   width="20%">
		      				<?php echo $entry_newsletter; ?>
	      				</td>
		      			<td class="tb_input"><?php if ($newsletter == 1) { ?>
              <input type="radio" name="newsletter" value="1" checked="checked" />
              <?php echo $text_yes; ?>
              <input type="radio" name="newsletter" value="0" />
              <?php echo $text_no; ?>
              <?php } else { ?>
              <input type="radio" name="newsletter" value="1" />
              <?php echo $text_yes; ?>
              <input type="radio" name="newsletter" value="0" checked="checked" />
              <?php echo $text_no; ?>
              <?php } ?></td>
	      			</tr>
	      		-->
	      	</TABLE>
	      	 
	      	 	<br/>
	      	 	
	      	 	
            	
      <div >
        <table>
          <tr>
            <td align="right" class="tb_center" width="5">
            	
            	<div class="galib_btn1">
            		<a onclick="$('#create').submit();"><?php echo $button_ok; ?></a>
            	</div>
            	
            	
            	
        	</td>
          </tr>
        </table>
      </div>
	  <!-- not used field -->
	  <input type="hidden" name="agree" value="1" />
	  <input type="hidden" name="company" value=" "/>
	  <input type="hidden" name="city" value=" "/>
	  <input type="hidden" name="country_id" value=" "/>
	  <input type="hidden" name="zone_id" value=" "/>
	  <input type="hidden" name="newsletter" value="0" />
	  <input type="hidden" name="ext" value=" " />
	  <input type="hidden" name="gender" value="0" />
	  
	  <!-- /not used field -->
      
      	
      
	      	 </form>
	        
	      </div></div>
       	 <!-- End - Left Side -->
       	 
       	



  <script type="text/javascript"><!--
$('select[name=\'zone_id\']').load('index.php?route=account/create/zone&country_id=<?php echo $country_id; ?>&zone_id=<?php echo $zone_id; ?>');
$('#postcode').load('index.php?route=account/create/postcode&country_id=<?php echo $country_id; ?>');
//--></script>
<?php echo $footer; ?> 